Scott Barkowski, Ph.D.

Assistant Professor

John E. Walker Department of Economics

Clemson University

Email: sbarkow {at} clemson {dot} edu

Curriculum Vitae

Fields of research interest

  • Health economics

  • Labor economics

  • Applied Econometrics

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Working Papers

Medicaid Expansion Spillovers to Health Care Consumption and Coverage: Evidence from Medicare Administrative Data (Under Review)

ABSTRACT: The 2014 Medicaid expansion excluded Americans over 65, but they could still be affected via spillover effects. Using Medicare administrative data, we test for spillovers in Medicaid coverage and Medicare spending among Medicare beneficiaries. We analyze two separate birth cohorts: those under 65 in 2014, who could have been induced by the expansion to take up Medicaid before joining Medicare; and those 65 or older in 2014, whose Medicaid eligibility was never affected by the expansion. Our analysis shows that spillovers only flowed into the under-65 cohort, with Medicaid coverage increasing and average Medicare spending falling for this group, with little effect on health conditions. A lack of an effect on those over 65 in 2014 suggests Medicare beneficiaries were not crowded out of health care access by the expansion. Instead, those under 65 used Medicaid to satisfy “pent-up” demand, consuming care they would have otherwise consumed later under Medicare.


Physician Response to Prices of Other Physicians: Evidence from a Field Experiment (Under Review)

ABSTRACT: I estimate the effect of prices of specialist physicians on primary care physician (PCP) referrals. My partner group of medical practices sent PCPs I chose randomly a price list for new referrals to ophthalmology practices. Using administrative referral data, I find that PCPs increased referral share to the least expensive ophthalmology practice by 147 percent during the first two months after treatment. Effects were only found for patients for whom the PCPs had cost reduction incentives, and dissipated over the following four months. For patients where PCPs had limited cost reduction incentives, I find little evidence of a treatment response.


Interpretation of Nonlinear Difference-in-differences: The Role of the Parallel Trends Assumption

ABSTRACT: I argue interpretation of nonlinear difference-in-differences models depends on the form of the parallel trends assumption. When they are assumed in the natural scale of the dependent variable, the treatment effect is the interaction effect (a cross-difference). If they are assumed in the transformed scale, it is a single difference. I further note that assuming parallel trends in one scale implies they do not hold in the other, except in special cases. Finally, I consider log-linear (and related) difference-in-differences models and provide a constant form of the treatment effect that is comparable across applications with different parallel trends assumptions.


Work in Progress

OK Boomer? Burden of Proof Law and Age Discrimination

Educational Impacts of Making College Tuition Free


Published / Accepted Articles

Young Children and Parents' Labor Supply during COVID-19

ABSTRACT: We study the effect of childcare needs during the COVID-19 pandemic on parental labor supply. Using monthly Current Population Survey data and following a pre-analysis plan, we implement three variations of an event-study research design comparing workers with and without childcare responsibilities. The first compares parents with young children to adults without young children, while the second and third rely on the presence of someone who could provide childcare in the household: a teenager in one and a grandparent in the other. Across these approaches, we find childcare needs did not negatively affect parents’ labor supply during the pandemic, with some evidence suggesting parents with childcare requirements were more often working. In terms of gender heterogeneity, we do not find any difference in the likelihood of working between men and women. For hours worked, however, some estimates suggest small increases only for mothers. At the onset of the pandemic, many employers adopted flexible working arrangements. We provide evidence suggesting the ability to work remotely may have helped parents avoid labor supply decreases.


In Sickness and in Health: Interaction Effects of State and Federal Health Insurance Coverage Mandates on Marriage of Young Adults

ABSTRACT: We study the interaction of state and federal dependent health insurance mandates on young adult marriages. Using a new dataset on state-level mandates, we show marriage restrictions of these laws reduced marriage likelihoods by about two percentage points. When the Affordable Care Act (ACA) was enacted, its mandate ended marriage restrictions, encouraging marriage among those previously eligible for state mandates. However, among those ineligible for state mandates, it discouraged marrying to obtain insurance through spouses. The combination of these contrasting ACA effects eliminated the marriage gap. We also find these marriage effects resulted in corresponding impacts on out-of-wedlock births.


A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage

ABSTRACT: We study state and federal health insurance coverage mandates for young adults. Despite consistent findings that the Affordable Care Act's (ACA) federal mandate was effective, research has disagreed on whether pre-existing, state-level mandates were successful in increasing coverage. We reconsider the issue with a new analytical perspective and newly available, accurate data on state mandates. We show that the impact of the state mandates was substantive and concentrated among young adults between ages 19 and 23. Our estimates indicate that the dependent coverage rose by 3.9 percentage points and overall coverage rose by 3.3 percentage points. Crowd out of coverage through young adults' own jobs was negligible. For those above 23, we find little evidence of changes in coverage. We incorporate these insights into analysis of the ACA's mandate, showing its effects were focused among those who were not eligible for state mandates, or were eligible but older than 23. Our results suggest eligibility restrictions played important roles in limiting the scope of the state mandates, but they can be practical and effective tools for policymakers looking to ensure or expand coverage for young adults in the face of uncertainty about the ACA.


Does Government Health Insurance Reduce Job Lock and Job Push?

ABSTRACT: I study job lock and job push, twin phenomena believed to be partially due to employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers to identify changes in those workers’ reliance on ECHI, I estimate notable job lock and job push effects. For married male workers, a 15 percentage point increase in the likelihood a household member is eligible for Medicaid increases the rate of voluntary job exits over a four-month period by 14 percent. For job push, the same increase in a household member’s likelihood of Medicaid eligibility reduces the transition rate into jobs with ECHI among all male workers by 8 percent.


The Effect of Health Insurance on Crime: Evidence from the Affordable Care Act Medicaid Expansion

ABSTRACT: Little evidence exists on the effect of the Affordable Care Act (ACA) on criminal behavior, a gap in the literature that this paper seeks to address. Using a simple model, we argue we should anticipate a decrease in time devoted to criminal activities in response to the expansion, since the availability of the ACA Medicaid coverage raises the opportunity cost of crime. This prediction is particularly relevant for the ACA expansion since it primarily affects childless adults, a population likely to contain individuals who engage in criminal behavior. We validate this forecast empirically using a difference-in-differences framework, estimating the expansion's effects on panel datasets of state- and county-level crime rates. Our estimates suggest that the ACA Medicaid expansion was negatively associated with burglary, vehicle theft, homicide, robbery, and assault. These crime-reduction spillover effects represent an important offset to the government's cost burden for the ACA Medicaid expansion.


Does Regulation of Physicians Reduce Health Care Spending?

ABSTRACT: The medical community argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous studies, however, have ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that, contrary to conventional wisdom, spending does not rise in response to increased risk. An increase in adverse actions of 16 (the year-to-year average) is associated with statistically significant, annual decreases in state spending on hospital care of approximately $22 million, and on prescription drugs of nearly $10 million. Malpractice payments are estimated to have smaller, statistically insignificant effects.


Does Employer-provided Health Insurance Constrain Labor Supply Adjustments to Health Shocks? New Evidence on Women Diagnosed with Breast Cancer

ABSTRACT: Employment-contingent health insurance may create incentives for ill workers to remain employed at a sufficient level (usually full-time) to maintain access to health insurance coverage. We study employed married women, comparing the labor supply responses to new breast cancer diagnoses of women dependent on their own employment for health insurance with the responses of women who are less dependent on their own employment for health insurance, because of actual or potential access to health insurance through their spouse’s employer. We find evidence that women who depend on their own job for health insurance reduce their labor supply by less after a diagnosis of breast cancer. In the estimates that best control for unobservables associated with health insurance status, the hours reduction for women who continue to work is 8 to 11 percent smaller. Women’s subjective responses to questions about working more to maintain health insurance are consistent with the conclusions from observed behavior.


Just For Fun

Economics Conference Bingo

ABSTRACT: We describe a bingo-style game intended to be played at economics conferences. Early results from implementation of the game by economists at conferences suggest that fun increases more than a full standard deviation. Further study of the effects of the game is ongoing.